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DSH160058BG UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
Subdivision Name
UNIVERSITY OF IOWA HEALTH CARE - FOOD NUTR SPORTS MED CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160058BG
Medicare Provider Number
160058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/9/2024
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
1/1/2025
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
University of Iowa Health Care
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371
Primary Contact
University of Iowa Health Care
Becky Marie Triplett, Manager, 340B and Compliance
(319) 384-5583
Addresses
Street Address
UI SPORTS MEDICINE
2701 PRAIRIE MEADOW DR
IOWA CITY, IA 52242-8001
Billing Address
University of Iowa Accounts Payable
202 PCO
Iowa City, IA 52242
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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